| NPI | 1548231228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA07151700) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 2171001) |
| 207N00000X Dermatology (Licence: VA 0101220994) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2007-07-08 |